[Autoimmune coagulation factor V/5 deficiency during chronic disseminated intravascular coagulation].

Aortic regurgitation, a thoracoabdominal aortic aneurysm, chronic myeloid leukemia, and chronic kidney disease were all being treated at two hospitals for an 83-year-old man. He was admitted to the Department of Orthopedics at our hospital with a lumbar compression fracture. Later, he experienced melena, for which the Department of Internal Medicine was consulted. Due to the aberrant results of PT-INR (7.1) and a PTT > 200 seconds on a coagulation test, we suspected the presence of an autoimmune coagulation factor deficiency, and prednisolone immunosuppressive therapy medication was started right away. Due to a sharp decline in FV/5 activity, the presence of FV/5 inhibitors, and the presence of anti-FV/5 autoantibodies, a final diagnosis of autoimmune coagulation factor V (FV/5) deficiency was made. After the start of immunosuppressive therapy, the FV/5 inhibitor and anti-FV/5 autoantibodies disappeared, and the FV/5 activity progressively returned to normal. Disseminated intravascular coagulation-which may have been caused by a known aortic aneurysm-worsened while tapering off prednisolone. Due to the patient's advanced age and other problems, the aneurysm was extensive and inappropriate for surgical repair. The coagulation test findings improved gradually upon initiation of warfarin therapy. Herein, the patient had autoimmune FV/5 deficiency, a rare disorder that made diagnosis and therapy difficult because of the patient's several coexisting conditions.

Comparison of the effects of pre-dilution and post-dilution online hemodiafiltration on the levels of inflammatory markers, lymphocytes, and platelets.

Online hemodiafiltration (OL-HDF) is a blood purification therapy based on diffusion and ultrafiltration and is classified into two types according to the mode of addition of the substitution fluid: pre-dilution OL-HDF (pre-HDF) and post-dilution OL-HDF (post-HDF); we previously reported that pre-HDF is more biocompatible. However, we used lower blood and substitution flow rates in that study and may not have accurately simulated the treatment conditions used in Europe. In this study, we compared the biocompatibilities of the treatment conditions of pre-HDF, commonly used in Japan, and post-HDF, commonly used in Europe, to determine the most biocompatible treatment conditions. We compared the biocompatibilities of pre-HDF and post-HDF using high blood flow rates and high substitution fluid volumes, and also compared the results with those of our previous study. We enrolled six stable patients undergoing maintenance dialysis at our clinic for this study. After the patients underwent hemodialysis (HD), post-HDF, and pre-HDF treatment, the biocompatibilities (based on the serum levels of high-sensitivity C-reactive protein, interleukin-6, pentraxin-3, ß-thromboglobulin, and soluble P-selectin, and the results of the lymphocyte blastogenesis test using phytohemagglutinin and concanavalin A as mitogens) and removal performances (removal performance for urea, creatinine, ß2-microglubulin [MG], and α1-MG, and albumin leakage) were determined. There were no significant differences in the biocompatibility parameters evaluated among the three treatment modes. Post-HDF was associated with significantly higher removal rates of ß2-MG than HD. Post-HDF was associated with significantly higher removal rate of α1-MG, and also significantly higher albumin leakage, than HD and pre-HDF.

The fate of methylmercury through the formation of bismethylmercury sulfide as an intermediate in mice.

A previous study by our group indicated that methylmercury (MeHg) is biotransformed to bismethylmercury sulfide [(MeHg)2S)] by interaction with reactive sulfur species (RSS) produced in the body. In the present study, we explored the transformation of MeHg to (MeHg)2S in the gut and the subsequent fate of (MeHg)2S in vitro and in vivo. An ex vivo experiment suggested the possibility of the extracellular transformation of MeHg to (MeHg)2S in the distal colon, and accordingly, the MeHg sulfur adduct was detected in the intestinal contents and feces of mice administered MeHg, suggesting that (MeHg)2S is formed through reactions between MeHg and RSS in the gut. In a cell-free system, we found that (MeHg)2S undergoes degradation in a time-dependent manner, resulting in the formation of mercury sulfide and dimethylmercury (DMeHg), as determined by X-ray diffraction and gas chromatography/mass spectrometry, respectively. We also identified DMeHg in the expiration after the intraperitoneal administration of (MeHg)2S to mice. Thus, our present study identified a new fate of MeHg through (MeHg)2S as an intermediate, which leads to conversion of volatile DMeHg in the body.

Foraging activity of harbour porpoises around a bottom-gillnet in a coastal fishing ground, under the risk of bycatch.

Bycatch of harbour porpoises (Phocoena phocoena) by gillnets is a recognised threat to populations. To develop effective mitigation measures, understanding the mechanics of bycatch is essential. Previous studies in experimental conditions suggested foraging activity is an important factor influencing porpoises' reaction to gillnets. We acoustically observed the behaviour of wild harbour porpoises around a bottom-gillnet set-up in a commercial fishing ground, especially foraging activity. Passive acoustic event recorders (A-tags) were fixed to the ends of the gillnet, and recorded for 1 392 hours. Although harbour porpoises frequently and repeatedly appeared around the net each day, incidental bycatch occurred only three times during the observations. The stomach contents of two individuals contained mainly Ammodytes sp., which were observable around the bottom-gillnet but not targeted by the fishery. A total of 276 foraging incidents were acoustically detected, and 78.2% of the foraging activity was in the bottom layer (deeper than 25 m). Porpoises appeared around the net with more frequency on the day of a bycatch incident than on the days without bycatch. These results suggest that the harbour porpoises appeared around the bottom-gillnet to forage on fish distributed in the fishing ground, but not captured by this bottom-gillnet. Thus, porpoises face the risk of becoming entangled when foraging near a gillnet, with the probability of bycatch simply increasing with the length of time spent near the net. Bycatch mitigation measures are discussed.

High accuracy cross-sectional shape analysis by coherent soft x-ray diffraction.

When the scatterer size is less than 100 wavelengths, the effect of diffraction is large. The analysis of diffraction is important for 3D shape measurement. However, in soft x rays, shapes suitable for rigorous diffraction analysis have been limited to ellipses and periodic structures. We have developed a method to expand this to any shape (isolated triangle, rectangle, etc.). Experimentally, we measured the respective widths of the cross section of a column consisting of two layers and showed that the resolution was at least a few wavelengths. For this purpose, we have also developed a fast simulation method with a small memory size.

A case of COVID-19 with the atypical CT finding.

COVID-19 usually demonstrates the specific pattern of chest CT findings (GGO, inverted-halo sign, etc). However, some COVID-19 cases show atypical CT findings. Physicians should make comprehensive judgments.

Evaluation of low-volume post-dilution online hemodiafiltration with Japanese high-performance hemodiafilters.

PURPOSE: To assess the removal performance of low-volume post-hemodiafiltration (HDF) with Japanese hemodiafilters and the removal performance with 20 % reduction in the total dialysate flow rate (Qdtotal). METHODS: Subjects were 8 patients undergoing pre-HDF. Study 1: Post-HDF was performed at a blood flow rate (Qb) of 250 mL/min and a total volume of substitution fluid (Vs) of 12 L/session(s) for 4 hrs using Fineflux-210Seco (FIX), ABH-21PA (ABH), and NVF-21H (NVF). We assessed removal efficiency of small molecular solutes, low-molecular-weight-proteins and the amount of albumin loss. Study 2: Post-HDF was performed at Vs of 12 L/s under G-1, Qdtotal of 500 and Qb of 250 mL/min; G-2, Qdtotal of 400 and Qb of 250 mL/min; and G-3, Qdtotal of 400 and Qb of 300 mL/min. Removal efficiency was compared and analyzed between these conditions. RESULTS: Study 1: The results using FIX, ABH and NVF are shown in order. The Kt/V were 1.8, 1.9 and 1.8. The ß2-Microglobulin (MG) removal rate (RR) (%) were 81.2, 83.1 and 82.8, and the α1-MG RR were 37.4, 40.2 and 38.5, respectively. Study 2: The results in G-1, 2 and 3 are shown in order. The Kt/V and the RR of small solutes, were significantly higher in G-3. The ß2-MG RR (%) were 81.2, 80.1 and 81.0, and the α1-MG RR were 37.4, 37.5 and 38.0, respectively. CONCLUSIONS: Low-volume post-HDF performed at Qb of 250 mL/min with Japanese high-performance hemodiafilters exhibited favorable removal efficiency for all solutes. Even with 20 % reduction in Qdtotal, the removal performance was also favorable.

Therapeutic effect of high-efficiency online hemodiafiltration for recurrent restless legs syndrome in dialysis patients.

Two dialysis patients developed recurrent restless legs syndrome. The clinical courses and the association between the α1-microglobulin removal rate and the therapeutic effects of hemodiafiltration were analyzed. Case 1: a middle-aged woman was switched from predilution online hemodiafiltration to hemodialysis, following which the α1-microglobulin removal rate decreased from 39.1 to 29.9%. A month later, the severe restless legs syndrome occurred. The treatment was then switched to high-efficiency hemodiafiltration and 2 weeks later, these symptoms were resolved. The α1-microglobulin removal rate increased to 41.9%. Her symptoms recurred 5 years later with severity; thus, the hemodiafiltration treatment conditions were changed. Under revised conditions, the α1-microglobulin removal rate was 42.6%, and her symptoms were alleviated. Continuation of high-efficiency hemodiafiltration led to the resolution of the syndrome at 1 month after recurrence. Case 2: a middle-aged man on hemodialysis developed the restless legs syndrome in the second year of treatment. The α1-microglobulin removal rate was 23.8%. After switching to a month-long high-efficiency hemodiafiltration with a removal rate of ≥ 40%, his symptoms were resolved. However, the syndrome recurred after a year with severity. The symptoms were alleviated using various measures. The hemodiafilters were changed, and hemodiafiltration with an α1-microglobulin removal rate of ≥ 40% was continued; 2 months later, his symptoms resolved. High-efficiency online hemodiafiltration is an effective therapeutic strategy for restless legs syndrome in dialysis patients. We found, for the first time, that target removal efficiency is an α1-microglobulin removal rate of 40% or higher.

Light-induced assembly of living bacteria with honeycomb substrate.

Some bacteria are recognized to produce useful substances and electric currents, offering a promising solution to environmental and energy problems. However, applications of high-performance microbial devices require a method to accumulate living bacteria into a higher-density condition in larger substrates. Here, we propose a method for the high-density assembly of bacteria (106 to 107 cells/cm2) with a high survival rate of 80 to 90% using laser-induced convection onto a self-organized honeycomb-like photothermal film. Furthermore, the electricity-producing bacteria can be optically assembled, and the electrical current can be increased by one to two orders of magnitude simply by increasing the number of laser irradiations. This concept can facilitate the development of high-density microbial energy conversion devices and provide new platforms for unconventional environmental technology.

Recent Progresses in Nanometer Scale Analysis of Buried Layers and Interfaces in Thin Films by X-rays and Neutrons.

In the early 1960s, scientists achieved the breakthroughs in the fields of solid surfaces and artificial layered structures. The advancement of surface science has been supported by the advent of ultra-high vacuum technologies, newly discovered and established scanning probe microscopy with atomic resolution, as well as some other advanced surface-sensitive spectroscopy and microscopy. On the other hand, it has been well recognized that a number of functions are related to the structures of the interfaces, which are the thin planes connecting different materials, most likely by layering thin films. Despite the scientific significance, so far, research on such buried layers and interfaces has been limited, because the probing depth of almost all existing sophisticated analytical methods is limited to the top surface. The present article describes the recent progress in the nanometer scale analysis of buried layers and interfaces, particularly by using X-rays and neutrons. The methods are essentially promising to non-destructively probe such buried structures in thin films. The latest scientific research has been reviewed, and includes applications to bio-chemical, organic, electronic, magnetic, spintronic, self-organizing and complicated systems as well as buried liquid-liquid and solid-liquid interfaces. Some emerging analytical techniques and instruments, which provide new attractive features such as imaging and real time analysis, are also discussed.

Expanding a polarized synchrotron beam for full-field x-ray fluorescence imaging.

Full-field x-ray fluorescence (XRF) imaging is an efficient technique for investigating element composition of a sample and the corresponding spatial distribution. Eliminating scattering x-rays is important for visualizing diluted/trace elements clearly. However, using the linear polarization of synchrotron radiation to remove scattering in full-field XRF imaging has not been feasible for many years because a synchrotron beam is inherently narrow in the direction perpendicular to the polarization and a large imaging area and a low scattering background cannot be simultaneously achieved. In this study, the trade-off was solved by expanding a synchrotron beam in the direction perpendicular to the polarization using an asymmetric-cut Si crystal. Large areas of samples were illuminated. In addition, a collimator plate, which only transmitted scattering x-rays that spread in the polarization direction, was used for imaging. Therefore, the detected scattering intensity was low. The present full-field XRF imaging scheme with a size-expanded polarized synchrotron beam is well suited for visualizing diluted/trace elements. It could be extended to x-ray absorption edge fine structure imaging for analyzing the chemical state of diluted/trace elements in inhomogeneous samples.

Thickness Changes in Temperature-Responsive Poly(N-isopropylacrylamide) Ultrathin Films under Ambient Conditions.

In this paper, we report detailed experimental observations of unusual changes in the thickness of solid poly(N-isopropylacrylamide) (PNIPAM) ultrathin films, which are well known to have temperature-responsive hydrophilic-hydrophobic switching properties. To date, a number of studies have been carried out on the bulk and the brush forms of PNIPAM in contact with liquid water, as well as in highly humid environments, and, recently, these ultrathin films have been preliminarily shown to exhibit temperature responses even under low-humidity, ambient conditions. In this work, the thicknesses of ultrathin PNIPAM films in a temperature/moisture-controlled sample stage were monitored continuously using multichannel X-ray reflectometry. At room temperature, the sample thickness showed an unexpected increase after thermal treatment at 70 °C for 3 h. In the temperature cycle between 15 and 60 °C, heating and cooling resulted in some clear differences. During cooling, initially, the thickness was almost constant but began to increase when the temperature exceeded 33 °C, which corresponds to the lower critical solution temperature (LCST). This observation indicates that the PNIPAM ultrathin film is sensitive to the small amounts of water contained in the air, even under ambient, low-humidity conditions. On the other hand, during heating run from 15 to 60 °C, the humidity dependence was monotonic, and no specific changes in the PNIPAM films were observed at around the LCST. By studying the humidity dependence, we found that the hydrophilic and hydrophobic states of the PNIPAM ultrathin film exhibit different temperature dependence behaviors. In addition, we found that swelling takes place even under low-moisture conditions. To understand the difference in the thickness changes observed on cooling and heating further, some models considering the effect of the boundary conditions in the polymer ultrathin film system were considered. In the case of the ultrathin film, the hydrophilic/hydrophobic switching property occurred only in the surface layer, which dominated the absorption of water molecules from air. In contrast, the interface layer was time-stable and provided an escape route for water molecules during heating.

Cutaneous p38 mitogen-activated protein kinase activation triggers psoriatic dermatitis.

BACKGROUND: Psoriasis is a chronic inflammatory skin disease characterized by IL-17-mediated immune responses. p38 is known to be highly activated in the psoriatic epidermis; however, whether p38 is involved in the development of psoriasis is unclear. OBJECTIVE: We sought to demonstrate that activation of p38 mitogen-activated protein kinase is sufficient to induce psoriatic inflammation in mice and that cutaneous p38 activities are the topical therapeutic targets for psoriasis. METHODS: A p38 activator, anisomycin, was applied daily to murine skin. Transcriptomic analyses were performed to evaluate the similarities of the skin responses to those in human psoriasis and the existing animal model. BIRB796, a small-molecule inhibitor targeting p38 activities, was applied to the murine psoriatic models topically or to human psoriatic skin specimens ex vivo. RESULTS: Topical treatment with anisomycin induced key signatures in psoriasis, such as epidermal thickening, neutrophil infiltration, and gene expression of Il1a, Il1b, Il6, Il24, Cxcl1, Il23a, and Il17a, in treated murine skin. These responses were fully abrogated by topical treatment with BIRB796, and were reduced in IL-17A-deficient mice. Transcriptomic analyses demonstrated the similarities of anisomycin-induced dermatitis to human psoriasis and imiquimod-induced murine psoriatic dermatitis. Furthermore, BIRB796 targeting of p38 activities reduced expression of psoriasis-related genes in both human keratinocytes stimulated with recombinant IL-17A in vitro and psoriatic skin specimens ex vivo. CONCLUSION: Therefore our findings suggest that cutaneous p38 activation can be a key event in patients with psoriasis and a potential topical therapeutic target of a small molecule.

Neutron visualization of inhomogeneous buried interfaces in thin films.

When designing some functions in thin film systems, one of the key concepts is the structure of the constituent layers and interfaces. In an actual system, the layers and interfaces are often inhomogeneous in different scales, from hundreds of microns to several nanometers, causing differences in properties, despite very similar average structures. In this case, the choice of the observation point is critical to clarify the problem. Another critical aspect is the identification of these points by surveying the entire inhomogeneous thin film system. This article presents a description of a novel promising solution that is suitable for nondestructive visualization of inhomogeneous buried layers and interfaces in thin films. Such observations have been impossible until now. In this investigation, a unique extension of neutron reflectometry is proposed. While conventional neutron reflectivity just gives average depth-profiling of the scattering length density of layered thin films, the present method provides full picture of the inhomogeneity. In general, achieving a high spatial-resolving power for neutron scattering is not straightforward because the neutron counts become fairly limited at the sample or the detector position when the beam size is reduced. As a result, XY scanning of a sample with a small neutron beam is fairly difficult because of the required long measurement time. To address these issues, new concepts have been introduced for neutron reflectivity. The proposed method uses a wide beam instead of reducing the beam size. In addition, it measures the projection reflection profile instead of the total integrated intensity. These profiles are collected at a set of different in-plane angles. Similar to computed tomography, it is possible to obtain the specimen's two-dimensional (2D) neutron reflectivity distribution as one image. Because the spatial resolution is limited by the detection method, a Hadamard coded mask is employed to measure the reflection projection with only 50% loss of the primary neutron intensity. When the time-of-flight (ToF) mode is used for the neutron experiment, one can obtain many images as a function of ToF, i.e., the wavevector transfer. Such series of images can be displayed as a video. This indicates that the neutron reflectivity profiles of local points can be retrieved from the above video images. This paper presents the first report on the development of neutron reflectivity with imaging capability, and the analysis of local points in inhomogeneous layered thin-films without utilizing a small neutron beam. In the present work, the feasibility of the proposed method with approximately 1 mm spatial resolution was examined. In addition, further improvements of the approach are discussed. It is anticipated that this technique will facilitate new opportunities in the study of buried function interfaces.

Multi-element X-ray movie imaging with a visible-light CMOS camera.

For many years, X-ray movies have been considered a promising tool for exploring and providing insights into chemical reactions. A simultaneous multi-element X-ray movie can further clarify the behavior difference of various elements and help investigate their interactions. The present short communication illustrates how to conduct multi-element X-ray movie imaging in a synchrotron facility solely by placing a micro-pinhole in front of a visible-light complementary metal-oxide semiconductor (CMOS) camera. It has been found that the CMOS camera can resolve X-ray fluorescence spectra when it is specially operated. In this work, a spatial resolution of ∼15 µm was achieved. In the X-ray movie, a movie frame acquisition time of 2 min and a spatial resolution of ∼50 µm were simultaneously achieved. It is clear that the CMOS camera can be a cost-efficient option for many researchers who wish to establish their own setup for visualizing chemical diffusion in various reactions.

Current approaches to middle molecule removal: room for innovation.

Aggressive removal of middle molecules or larger low-molecular-weight proteins (LMWPs) has been a growing concern following studies on their harmful effects on the mortality and morbidity of chronic dialysis patients. To remove larger LMWPs and some protein-bound uremic toxins (PBUTs), high- and medium-cutoff (HCOs and MCOs, respectively) membranes, convective therapy and protein adsorptive membranes are available. When we use HCO or MCO membranes for convective therapy, we have to take care to avoid massive albumin leakage during a dialysis session. Convection volume is an important element to increase middle molecule removal; however, a larger convection volume has a risk of larger leakage of albumin. Predilution hemodiafiltration is a useful measurement to increase larger LMWPs without massive albumin leakage. ß2-microglobulin (B2M), α1-microglobulin (A1M) and albumin leakage during a dialysis session are useful parameters for assessing middle-molecule removal. Reduction ratios of B2M >80% and of A1M >35% are favorable to improve severe dialysis-related symptoms. The efficacy of middle molecule removal should be evaluated in comparison with clinical outcomes, mortality, morbidity and the improvement of dialysis-related symptoms. Recently some dialysis-related symptoms such as sleep disturbance, skin itchiness and dialysis hypotension have been recognized as good surrogate makers for mortality. Further studies to evaluate the relationship between middle molecule or PBUTs removal and the improvement of patient symptoms should be performed in well-designed randomized controlled trials.

Versatile chemical handling to confine radioactive cesium as stable inorganic crystal.

The present paper describes an extremely efficient, reproducible and inexpensive chemical handling method for converting the nuclear wastes contaminated by radioactive cesium to stable inorganic crystal, pollucite (CsAlSi2O6), which is promising as a form of the final storage. In this processing, the clays are used as a source for aluminum and silicon, and it is important to get a well-mixed homogenous solution by the aid of some heat and pressure. The present method proposes the use of ethylene glycol as a solvent, rather than water. It has been found that one can obtain crystalline pollucite by heating up to 350 °C in a high-pressure container (~15 MPa), mixed with montmorillonite - an abundant natural clay and ethylene glycol. It has been found that the reduction of the amount of water helps to achieve very high confinement rate in a reasonable time of few~20 h. This will be fairly important in processing contaminated water in the nuclear power plant. The influence of seawater has been also examined.